scholarly journals Preparing for the NASH Epidemic: A Call to Action

2021 ◽  
Author(s):  
Fasiha Kanwal ◽  
Jay H. Shubrook ◽  
Zobair Younossi ◽  
Yamini Natarajan ◽  
Elisabetta Bugianesi ◽  
...  
Keyword(s):  
Professional Associations ◽  
Primary Care Providers ◽  
High Yield ◽  
Care Providers ◽  
Public Health Response ◽  
Full Spectrum ◽  
Nonalcoholic Fatty Liver ◽  
Call To Action ◽  
Health Response ◽  
Needs Assessment Survey

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common <br>conditions with a rising burden. Yet, there are significant management gaps between clinical <br>guidelines and practice in patients with NAFLD and NASH. Further, there is no single global <br>guiding strategy for the management of NAFLD and NASH. The American Gastroenterological <br>Association, in collaboration with seven professional associations, convened an international <br>conference comprising 32 experts in gastroenterology, hepatology, endocrinology, and primary <br>care providers from the U.S., Europe, Asia, and Australia. Conference content was informed by <br>the results of a national NASH Needs Assessment Survey. The participants reviewed and <br>discussed published literature on global burden, screening, risk stratification, diagnosis, and <br>management of individuals with NAFLD, including those with NASH. Participants identified <br>promising approaches for clinical practice and prepared a comprehensive, unified strategy for <br>primary care providers and relevant specialists encompassing the full spectrum of NAFLD/NASH <br>care. They also identified specific high-yield targets for clinical research and called for a unified, <br>international public health response to NAFLD and NASH.

scholarly journals Preparing for the NASH Epidemic: A Call to Action

2021 ◽  
Author(s):  
Fasiha Kanwal ◽  
Jay H. Shubrook ◽  
Zobair Younossi ◽  
Yamini Natarajan ◽  
Elisabetta Bugianesi ◽  
...  
Keyword(s):  
Professional Associations ◽  
Primary Care Providers ◽  
High Yield ◽  
Care Providers ◽  
Public Health Response ◽  
Full Spectrum ◽  
Nonalcoholic Fatty Liver ◽  
Call To Action ◽  
Health Response ◽  
Needs Assessment Survey

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common <br>conditions with a rising burden. Yet, there are significant management gaps between clinical <br>guidelines and practice in patients with NAFLD and NASH. Further, there is no single global <br>guiding strategy for the management of NAFLD and NASH. The American Gastroenterological <br>Association, in collaboration with seven professional associations, convened an international <br>conference comprising 32 experts in gastroenterology, hepatology, endocrinology, and primary <br>care providers from the U.S., Europe, Asia, and Australia. Conference content was informed by <br>the results of a national NASH Needs Assessment Survey. The participants reviewed and <br>discussed published literature on global burden, screening, risk stratification, diagnosis, and <br>management of individuals with NAFLD, including those with NASH. Participants identified <br>promising approaches for clinical practice and prepared a comprehensive, unified strategy for <br>primary care providers and relevant specialists encompassing the full spectrum of NAFLD/NASH <br>care. They also identified specific high-yield targets for clinical research and called for a unified, <br>international public health response to NAFLD and NASH.

scholarly journals Health, housing, and ‘direct threats’ during a pandemic

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Jennifer K Wagner
Keyword(s):  
Public Health ◽  
Health Care Providers ◽  
Care Providers ◽  
Human Right ◽  
Public Health Response ◽  
Primary Responsibility ◽  
Health Response ◽  
Force Majeure ◽  
The Government ◽  
Direct Threat

Abstract The COVID-19 pandemic brought into stark relief the intimate nexus between health and housing. This extraordinary infectious disease outbreak combined with the astounding lack of a clear, coordinated, prompt, and effective public health response in the U.S. created conditions and introduced practical challenges that left many disoriented-not only health care providers but also housing providers. Innumerable issues are worth examination, such as implications of moratoria on evictions and foreclosures, force majeure contract clauses, insurability of pandemic-related damages and disruptions, holdover tenancies and delayed occupancies, and possible abatement of rent or homeowner/condominium association dues in light of closed common facilities (such as fitness areas) or reduced benefits to be enjoyed with residential property; however, this article focuses on fair housing law and the ``direct threat'' exemption; finds it unlikely that COVID-19 is a disability, likely that the ``direct threat'' defense is available, and both determinations to be case-specific inquiries dependent upon rapidly-changing scientific understanding of this disease. By highlighting adequate housing as a human right for which the government has primary responsibility for ensuring its achievement, this article underscores the importance of finding a holistic solution to public health and housing problems before the next public health emergency arises.

Nonalcoholic Fatty Liver Disease (NAFLD) for Primary Care Providers: Beyond the Liver

2020 ◽  
Vol 16 ◽  
Author(s):  
Eddison Godinez-Leiva ◽  
Fernando Bril
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Systemic Disease ◽  
Primary Care Providers ◽  
Major Public Health Problem ◽  
Care Providers ◽  
Nonalcoholic Fatty Liver

Abstract:: Nonalcoholic fatty liver disease (NAFLD) has consolidated as a major public health problem, affecting ~25% of the global population. This percentage is significantly higher in the setting of obesity and/or type 2 diabetes. Presence of NAFLD is associated with severe liver complications, such as nonalcoholic steatohepatitis (NASH; i.e., presence of inflammation and necrosis), cirrhosis and hepatocellular carcinoma. However, the majority of these patients die of cardiovascular disease. For this reason, management of this condition requires a multidisciplinary team, where primary care providers are at center stage. However, important misconceptions remain among primary care providers, preventing them from appropriately approach these patients. Nonalcoholic fatty liver disease should be understood as part of a systemic disease, characterized for abnormal accumulation of fat in tissues other than the adipose tissue. This, in turn, produces dysfunction of those organs or tissues (process sometimes referred to as lipotoxicity). Therefore, due to the systemic nature of this condition, it should not surprise that NAFLD is closely related to other metabolic conditions. In this review, we will focus on the extrahepatic manifestations of NAFLD and its metabolic and cardiovascular implications. We believe these are the most important issues primary care providers should understand, in order to effectively manage these complicated patients. In addition, we have provided a simple and straightforward approach to the diagnosis and treatment of patients with NAFLD and/or NASH. We hope this review will serve as a guide for primary care providers to approach their patients with NAFLD.

Pain Care Essentials

2019 ◽  
Keyword(s):  
Clinical Practice ◽  
Nurse Practitioners ◽  
Clinical Skills ◽  
Core Competencies ◽  
Physician Assistants ◽  
Primary Care Providers ◽  
Care Providers ◽  
Multiple Choice Questions ◽  
Full Spectrum ◽  
Pain Care

Pain Care Essentials targets the needs of primary care providers and entry-level healthcare professionals to understand pain. Based on the successful approach of examining four basic questions, this textbook addresses: What is pain? How is pain assessed? How is pain managed? and How does clinical context impact pain experience and management? Weaving together advances in science and clinical practice, this text covers the full spectrum from basic pain signaling mechanisms, psychology, and epidemiology, to clinical skills, treatment choices, and impacts on children, older adults, and those with substance use disorders, at a depth attuned to the foundations of clinical practice. Based on a learner-centered teaching philosophy; we believe that a deeper understanding of patient-centered pain care, including socioemotional development, enhances the clinical experience for patients, caregivers, and healthcare providers; leading to better outcomes, higher levels of patient satisfaction, and less provider burnout. Each chapter includes learning objectives, a clinical case, multiple choice questions, and selected references. Figures, tables, and textboxes enhance reader engagement. The goal is to deliver essential pain content that can be incorporated into an integrated curriculum preparing students for formative and summative assessments of core competencies in pain, as well as meeting the needs of the more experienced general reader seeking a quick update. Prepared by an interprofessional authorship team for an audience that includes physicians, nurse practitioners, physician assistants, pharmacists, and students of all healthcare professions, this work fills an important gap by focusing on pain as encountered by the broadest spectrum of healthcare practitioners.

scholarly journals Opioid use among cancer survivors: A call to action for oncology and primary care providers

Cancer ◽  
2017 ◽  
Vol 124 (3) ◽  
pp. 648-649 ◽  
Author(s):  
Larissa Nekhlyudov ◽  
Olaf P. Geerse ◽  
Catherine M. Alfano
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Care Providers ◽  
Opioid Use ◽  
Call To Action

scholarly journals Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040398
Author(s):  
Jonila Gabrani ◽  
Christian Schindler ◽  
Kaspar Wyss
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Professional Associations ◽  
Primary Care Providers ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Public Facility ◽  
Care Providers ◽  
Cross Sectional ◽  
Factors Influencing

ObjectivesTo identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.DesignA cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.SettingExit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July–August 2018.ParticipantsRepresentative sample of 629 adults ≥18 years of age.Main outcomes measures(1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients’ decision to attend a given provider. Data were analysed using mixed logistic regression models.ResultsNearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were ‘quality of care’ and ‘healthcare professionals’ attitudes. Solely looking at patients using a public provider, ‘geographical proximity’ was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider’s patients, the ‘availability of diagnostic devices’ was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).ConclusionThe use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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